Journal
HEART
Volume 98, Issue 19, Pages 1418-1423Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/heartjnl-2012-302457
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Funding
- NHS North of Tyne (Newcastle Primary Care Trust)
- British Heart Foundation [PG/08/026/24 712]
- UK Medical Research Council
- Biotechnology and Biological Sciences Research Council [G0500997]
- Dunhill Medical Trust [R124/0509]
- British Heart Foundation Personal Chair
- UK NIHR Biomedical Research Centre for Age and Age Related Disease
- MRC [MR/J50001X/1, G0500997] Funding Source: UKRI
- British Heart Foundation [RG/08/012/25941] Funding Source: researchfish
- Medical Research Council [G0700718B, MR/J50001X/1, G0500997] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10260] Funding Source: researchfish
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Objective Heart failure (HF) prevalence rises sharply among those aged 85 years and over. Previous population based echocardiographic studies of left ventricular (LV) dysfunction, the substrate for HF, have included only small numbers in this age group. We used domiciliary echocardiography to estimate the prevalence of LV systolic and diastolic dysfunction in 87-89 year olds and the proportion remaining undiagnosed. Design Cross sectional analysis of data from Newcastle 85+ Study. Setting Primary care, North-East England. Participants 376 men and women aged 87-89 years. Measures Domiciliary echocardiography was performed and LV systolic and diastolic function was graded. The presence of limiting dyspnoea was assessed by questionnaire. Previous diagnoses of HF were abstracted from general practice (GP) records. Results 32% of participants (119/376) had LV systolic dysfunction (ejection fraction (EF) <= 50%) and a further 20% (75/376) had moderate or severe LV diastolic dysfunction with preserved EF. Both echocardiographic assessment of LV function and dyspnoea status were available in 74% (278/376) of participants. Among these participants, limiting dyspnoea was present in approximately two thirds of those with significant (systolic or isolated moderate/severe diastolic) LV dysfunction. 84% (73/87) of participants with significant LV dysfunction and limiting dyspnoea did not have a preexisting HF diagnosis in their GP records. Overall, 26% (73/278) of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction. Conclusion Significant systolic and diastolic LV dysfunction is much commoner in community dwelling 87-89 year olds than previous studies have suggested. The majority are both symptomatic and undiagnosed.
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